Abstract
Purpose :
Large choroidal melanomas are still a common presentation. Treatment with plaque brachytherapy (PB) has historically demonstrated poor outcomes including increased risk of local failure and severe vision loss. The purpose of our study is to report on the outcomes for large choroidal melanomas treated with PB and prophylactic adjuvant bevacizumab.
Methods :
A prospective consecutive case series of patients with large choroidal melanomas treated with I-125 (125I) PB. Outcomes included local tumor failure, survival, secondary enucleation and visual acuity.
Results :
In total, 87 patients with a large choroidal melanoma were identified. 54 (62.1%) patients were treated with PB and 33 (37.9%) were treated with primary enucleation. A large choroidal melanoma was defined as having a maximum tumor diameter of >16.0 mm or an apex height >10.0 mm regardless of diameter. Of the 33 primary enucleation patients, the mean tumor apex height was 11.1 ± 2.8 mm (3.5 mm – 14.9 mm) and the mean maximal basal diameter was 16.6 ± 3.2 mm (10.5 mm – 23.0 mm). Of the 54 PB patients, the mean tumor apex height was 9.3 ± 3.0 mm (2.0 mm – 14.8 mm) and the mean maximal basal diameter was 16.7 ± 2.2 mm (9.2 mm – 20.5 mm). Of the 54 PB patients, the overall survival rate was 35/54 (64.8%) with a mean follow-up time was 3.6 ± 95% confidence interval of 2.5 years. The local failure rate was 0/54 (0.0%) and the secondary enucleation rate was 3/54 (5.6%). Visual acuity was better than 20/200 in 40% of the patients at a mean follow-up time of 3.6 ± 2.5 years.
Conclusions :
Plaque brachytherapy provides excellent local tumor control, an eye preservation rate of 94.4%, and a 65% overall survival rate with a mean follow-up of 3.5 years. Visual acuity was better than 20/200 in 40% of the patients.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.